Posts Tagged ‘HIEs’

5 Ideas to Improve ACO Performance Results

June 19th, 2014 by Cheryl Miller

One step John C. Lincoln network took to improve performance results at the end of its first year as a Medicare Shared Savings Program accountable care organization (MSSP ACO) was to focus on a relatively small number of patients, the top 5 percent of beneficiaries by claims volume who actually account for about 60 percent of medical spend, explains Heather Jelonek, CEO for ACOs at John C. Lincoln Network, who shares additional strategies here.

First, we decided to institute wellness visits across our health system. We’ve worked with several large third party payors here in the valley where they’re now recognizing the Medicare G-codes for wellness visits. We bring those patients in and get a full survey of what’s been going on with them.

Second, we’re engaging in regular population management. We now have our physicians talking about how often they want to see their patients with diabetes or hypertension or cancer.

Third, we’re also starting to focus on those individuals who are ‘aging in;’ those patients who are about 62½. We’re trying to get them in and get them into a routine, making sure they’ve got A1C scores every quarter and every six months, and have had their flu shots and colonoscopies. We’re hoping a healthier generation of individuals coming into the Medicare program improves the quality outcomes that we’ll see long-term.

Fourth, we’ve developed a standardization for our quality reporting. We’ve looked at the top 5 percent of our beneficiaries by claims volume, who actually account for about 60 percent of our medical spend. We’re hoping that by focusing on a relatively small number of patients, we’ll have a drastic impact on outcomes.

Next, we’re also leveraging our electronic medical record (EMR) to the fullest extent; we’re participating in a number of conversations and baseline studies with EPIC®. They are very interested in seeing what we’ve done with the tool and how we’re making it usable for our ACO reporting.

But the one thing that we will continue to struggle with and continue to dive deeply into is integration opportunities: talking to other communities, looking at health information exchanges (HIE’s) as we’re acquiring a new practice or signing a new community physician onto our ACO — bringing everybody to the table so that we’re all speaking the same language.

Excerpted from Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care.

Healthcare Business Week in Review: Medicare beneficiaries, Pediatric Mental Health, Hospital Scorecards

November 8th, 2013 by Cheryl Miller

The insurance marketplace rollout continues to be problematic for many consumers, but there is some good news for Medicare beneficiaries: they are seeing significant out-of-pocket savings since the ACA was implemented, savings that will most likely continue through 2014, CMS officials say. Plus, they don’t need to sign up for the new health insurance marketplaces, as they are already covered by Medicare.

Some disturbing news from the Annual American Academy of Pediatrics: mental health diagnoses for children have jumped 30 percent in the last four years, with ADHD leading the pack, followed by anxiety, depression, and eating disorders. Mental health diagnoses run about a third higher for children with Medicaid insurance compared with commercial coverage, researchers say, and clinicians need to seek a deeper understanding as to why. More inside.

Nearly 440,000 Americans are dying annually from preventable hospital errors, making them the third leading cause of death in the United States, according to a Fall 2013 update to The Leapfrog Group Hospital Safety Score report.

The annual report, which also assigns A, B, C, D and F grades to more than 2,500 U.S. general hospitals, shows that many hospitals are making headway in addressing errors, accidents, injuries and infections that kill or hurt patients, but overall progress is slow.

The extensive report also lists the states that earned the highest and lowest grades: among them, Maine claims the number one spot for the state with the highest percentage of “A” hospitals.

A significant and growing performance gap exists between dual eligible and non-dual eligible members when it comes to CMS Five-Star Quality rating measures, according to a study from Inovalon, Inc., a leading provider of data-driven healthcare solutions.

The study finds that a significant association exists between Medicare-Medicaid dual eligible status and lower performance on specific Part C and D measure Star ratings. The results point to the integral role that income, race/ethnicity, and gender play on the HEDIS® and CMS Part D measures used in the Five-Star rating system.

It’s not too late to take our Healthcare Trends in 2014 survey; from an early surge in Medicare ACOs to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 has been nothing short of unpredictable. Please tell us about the last 12 months and how your organization is preparing for 2014 by completing HIN’s ninth annual survey on Healthcare Trends by November 18, 2013. You’ll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential. One respondent will win a training DVD of the “2014 Healthcare Trends and Forecasts” webinar recorded on October 30, 2013.